Most recent score for sepsis
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Here is a full breakdown of the most current sepsis scoring landscape as of mid-2026:
Most Recent Score for Sepsis: SOFA-2 (October 2025)
The newest validated sepsis scoring system is SOFA-2, published in JAMA on October 29, 2025. It is the first major revision to the SOFA score in nearly 30 years.
What is SOFA-2?
- Developed by 60 experts analyzing data from 3.34 million patients across 1,300+ ICUs in 9 countries (2014-2023)
- Retains the original 6 organ systems (scored 0-4 each, max = 24), still calculated as the highest score per system within a 24-hour period
- Sepsis is still defined as SOFA increase ≥ 2 points in the setting of suspected infection
- Immune and gastrointestinal systems were evaluated but excluded due to insufficient predictive evidence
Key Changes from SOFA-1 to SOFA-2
Respiratory (major update):
| Points | SOFA-2 | SOFA-1 |
|---|---|---|
| 1 | P/F ≤ 300 or S/F ≤ 300 | P/F ≤ 400 |
| 2 | P/F ≤ 225 or S/F ≤ 250 | P/F < 300 |
| 3 | P/F ≤ 150 or S/F ≤ 200 + advanced vent support | P/F < 200 with resp support |
| 4 | P/F ≤ 75 or S/F ≤ 120 + advanced vent support or ECMO | P/F < 200 with resp support |
Kidney (major update):
| Points | SOFA-2 | SOFA-1 |
|---|---|---|
| 1 | Creatinine 1.2-2.0 / UO < 0.5 ml/kg/hr for 6-12 hrs | Cr 1.2-1.9 |
| 2 | Creatinine 2.0-3.5 / UO < 0.5 ml/kg/hr > 12 hrs | Cr 2.0-3.4 |
| 3 | Creatinine > 3.5 / UO < 0.3 ml/kg/hr > 24 hrs or anuria > 12 hrs | Cr 3.5-4.9 |
| 4 | Receiving or meeting criteria for dialysis (including chronic use) | Cr > 5.0 |
Cardiovascular (major update):
- Vasopressors scored only if administered as continuous IV infusion for ≥ 1 hour
- Dopamine thresholds updated: 2 pts for 20 mcg/kg/min, 3 pts for >20-40, 4 pts for >40
Liver (minor update):
| Points | SOFA-2 (Bilirubin mg/dL) | SOFA-1 |
|---|---|---|
| 1 | 1.2-3.0 | 1.2-1.9 |
| 2 | 3.0-6.0 | 2.0-5.9 |
| 3 | 6.0-12.0 | 6.0-11.9 |
| 4 | > 12.0 | > 12.0 |
Hemostasis (previously "Coagulation") - minor update to 3-point and 4-point thresholds:
| Points | SOFA-2 Platelets | SOFA-1 |
|---|---|---|
| 1 | ≤ 150,000 | < 150,000 |
| 2 | ≤ 100,000 | < 100,000 |
| 3 | 50,000-80,000 | < 50,000 |
| 4 | ≤ 50,000 | < 20,000 |
Other Scores Still in Use
| Score | Use |
|---|---|
| SOFA-2 (2025) | ICU; formal sepsis diagnosis and severity |
| qSOFA | Bedside screening outside ICU (≥ 2 of: altered mentation, RR ≥ 22, SBP ≤ 100) |
| NEWS2 | Ward-based early warning/trigger tool |
| Phoenix Score | Pediatric sepsis (validated 2024-2025, used in PICUs) |
| APACHE II/III | ICU severity; not sepsis-specific |
Recent Meta-Analysis
A 2024 systematic review and meta-analysis (Chua et al., PMID 38379353) compared early warning scores for sepsis identification and in-hospital mortality prediction, finding that no single score was superior across all settings - underscoring why SOFA-2 was developed to close these gaps.
Bottom line: SOFA-2, published in JAMA in October 2025, is the most up-to-date validated scoring tool for sepsis severity assessment. It brings the original 30-year-old SOFA score in line with modern ICU populations, updated drug therapies (including ECMO), and contemporary organ dysfunction definitions.
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